General OR Rotation
foundation of our training lies in the main operating room. More than half of
our operating rooms are dedicated to the great variety of procedures performed
in this ever-broadening arena: General Surgery, Plastic Surgery, Orthopedic
Surgery, Otolaryngology, Gynecology, Urology, Vascular Surgery, Neurosurgery
and Trauma Surgery comprise an abridged list of all those who work here.
The General OR is every resident's first
rotation, as well as where most of the first clinical training year is spent.
It is where our first two books are read and where the clinical habits of a
lifetime are forged. Our General Inpatient Operating Room is one of great
camaraderie and collegiality. We know how fortunate we are to get to perform
anesthesia every day and we do not forget it. It is our pleasure to instill
this same passion for the field in each of our residents.
We take an "Airway First" approach to
Anesthesiology. We initially teach the use of both common laryngoscope blades
along an anatomy guided algorithm. This same algorithm quickly leads to
training in ancillary airway devices of primary importance, such as the LMA and
bougie, as well as more advanced devices like the fiberoptic bronchoscope,
lightwand, Bullard and Glidescope. Every device has a failure rate, so we train
everyone in several different tools to provide safe redundancy. We especially
emphasize the awake intubation to remain comfortably aligned with the American
Board of Anesthesiology’s Difficult Airway Algorithm.
Our residents perform dozens of awake fiberoptic
intubations during their residency and can do so in 5-10 minutes. This
technique must be crisp and efficient or it will be underutilized later,
especially in the private sector. We teach numerous methods to obliterate the
cough and gag reflex to include nerve blocks and topical approaches. The
sedation for such procedures can be complex and is adjusted for each patient.
We have more than a dozen fiberscopes available in our operating room at all
times, which has allowed our residents to get their “scope time” below 10
seconds. The last 150 graduates from our program have acquired this skill
through the only known method for advanced skills acquisition: practice. We
also expect dozens of lightwands, intubating LMAs, bullards and glidescopes to
round out more than 200 ancillary airway intubations while training in our
Anesthetic maintenance is especially valued in
our training scheme because it is the key to a safe, smooth and timely
emergence. We teach and use isoflurane, sevoflurane, desflurane, as well as the
judicious use of nitrous oxide. Agent selection is a crucial decision we make
each case based upon procedure duration, closure time, opioid selection,
whether or not nitrous oxide can be used, and the storage characteristics of each
agent. Opioids are also crucial to the practice of anesthesiology. Although
advanced utilization will be taught on our Acute Pain Service, our Chronic Pain
month, and during our Neuroanesthesia rotations, the introduction to the
judicious use of opioids begins in the general operating room. By the end of
residency, our trainees are comfortable in the use of more than a dozen
opioids, and especially comfortable with intraoperative infusions of fentanyl,
sufentanil, alfentanil, and remifentanyl.
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